Nasotracheal Intubation in the Presence of Facial Fractures

To the Editor.—  As an anesthesiologist and an oral and maxillofacial surgeon, respectively, at Boston City Hospital, a major trauma center, we would like to comment on Dr Hall's¹ answer regarding nasotracheal intubation in a patient with fractures of the femur, mandible, and maxilla.Although not mandatory, it is preferable that maxillary and mandibular fractures be reduced and immobilized with intermaxillary fixation as soon as reasonably possible, as traumatic edema is at a minimum and delay in immobilization enhances the possibility of infection at compound fracture sites. In addition, early stabilization of maxillary fractures helps resolve rhinorrhea of cerebral fluid from the cribriform plate of the ethmoid bone.The reduction and stabilization of maxillary fractures require placing the patient's teeth in proper occlusion. Oral intubation significantly impedes this. Each patient and situation must be individually assessed and treated. A Le Fort I fracture of the maxilla does not involve